Healthcare Provider Details

I. General information

NPI: 1851348767
Provider Name (Legal Business Name): DEEPALI RAMESH HAZARIWALA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 24 BACK BAY FARM RD
LONG NECK DE
19966
US

IV. Provider business mailing address

136 CHESTNUT XING DR
NEWARK DE
19713-2672
US

V. Phone/Fax

Practice location:
  • Phone: 302-947-9662
  • Fax: 302-947-9692
Mailing address:
  • Phone: 302-738-9186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0000643
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE007591
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: